BOOK REVIEW

Holly Grigg-Spall has a story to tell. With her recent book, Sweetening the Pill or How We Got Hooked on Hormonal Birth Control, Grigg-Spall also has an altruistic agenda: to share her experience in the hope that it will encourage women to question their own use of hormonal contraceptives, and to consider alternatives.

Grigg-Spall begins Sweetening the Pill by telling her story of being prescribed the birth control pill Yasmin, which she describes as “a diet drug, a beauty product and a contraceptive all rolled into one, and doctor endorsed to boot.” After being on the pill for years she began to wonder if it was causing her brain fog, panic attacks, depression, loss of libido, urinary tract infections and a number of other health complaints. Then, she says, it “shook me awake” when she read that the pill may be altering her body chemistry and changing her “psychological state.” This was when Grigg-Spall decided to “stop taking the pill for good.” Around the same time she was also hearing similar stories from friends and family members, and after moving from the UK to the United States with her American boyfriend (now husband) she started a blog on the topic. Then the stories, comments, tweets, etc. started piling up.

The fact that Grigg-Spall writes about the contraceptive Yasmin (also marketed as Yaz) is important to this story. Yaz and Yasmin are among a group of drospirenone-containing oral contraceptives that have been reviewed by regulators in the United States and Canada due to deaths from venous thromboembolism, VTE, (blood clots) and strokes. In Canada, at least 23 deaths have been linked to these contraceptives. The FDA and Health Canada both concluded that Yaz and Yasmin should remain on the market; however, they also issued safety warnings in 2011 stating that other oral contraceptives with lower risk of VTE (those not containing drospirenone) should be the first choice for prescriptions. (See also Grigg-Spall’s Network article on Diane-35, an acne medication containing drospirenone that is prescribed off label as a contraceptive).

Speaking out against the pill, and other hormonal contraceptives, Grigg-Spall has tackled a controversial subject. It is a tricky business to call into question what many women consider a liberating force during the sexual revolution of the 1960s —a pill that gave women more control to prevent unwanted pregnancies. And Grigg-Spall has felt the sting of some negative reviews, in part due to flaws in her book, but also no doubt due to the unpopularity of her message for some people. [See CWHN Spring Talks Sex blog - January 2014]

The passion in Grigg-Spall’s story is indisputable. Unfortunately some of her research and arguments fall into the disputable category. Her book has been criticized by reviewers for spotty research and unsubstantiated claims about the adverse effects of oral contraceptives. However, Sweetening the Pill is a heartfelt and passionate account of a self-professed feminist that definitely demonstrates the feminist slogan that “the personal is political.”

Certain reviewers have allowed the book’s shortcomings to overshadow Grigg-Spall’s main purpose: to tell her personal story, and the stories of other women who have decided to “ditch the pill,” and to open a discussion about alternatives to hormonal contraception. Assuming one of Grigg-Spall’s goals was to stimulate discussion and debate, her book is a definite success, and she is to be congratulated for raising tough questions.

That said, the book has several problems. Grigg-Spall self-identifies as a feminist and even though she quotes other feminists and feminist organizations that have taken issue with the pill, she seems to see herself as a lone (or almost lone) crusader: “In this culture it is not easy to find footing between the misogyny of the religious Right and the feminist agenda with its own brand of misogyny, but I believe it is a position worth fighting for.” She adds, “it is a betrayal of the feminist cause to speak out with openness about the side-effects of the pill.”

This is the voice of a feminist frustrated by what she sees as engineered ignorance about the potential adverse health effects of all oral contraceptives stemming from a consumer culture and patriarchal society that refuses to entertain criticism of the pill. Part of that engineering machinery, as Grigg-Spall points out, is clearly the successful marketing of Yaz and Yasmin as lifestyle drugs for “aspirational living” and, for example, the Mirena IUD as the “Chanel handbag of the birth control world.” However, her conclusion—that women who choose to take the pill are deluded or duped by a consumerist and patriarchal culture—comes across as condescending. “The choice to take the pill is fiercely protected and yet that choice is rarely autonomous and informed.”

Grigg-Spall argues that feminists and women’s health organizations will not hear a word against the pill. “Why is it that we hear so little criticism of the pill coming from the side of the pro-choice, sex positive, feminist and liberal?” Here she seems to wrongly equate the position of Planned Parenthood as representative of feminist women’s health organizations across North America though she does give credit to Our Bodies Ourselves and the National Women’s Health Network in the United States for intervening during the FDA review of Yaz and Yasmin.

Grigg-Spall can be forgiven for leaving the Canadian perspective out of her book since she focuses mainly on the United States. However, the absence of any reference to diethylstilbestrol (DES)—the first synthetic estrogen developed in 1938—is a gap.

DES was prescribed to pregnant women to prevent miscarriage until 1971 when it was contraindicated for that use after being linked to a rare form of vaginal cancer in young girls who were exposed to the drug in utero. Consumer health organizations such as DES Action USA and DES Action Canada (and many more around the world) were formed by women and their children exposed to the drug. These organizations were justifiably wary of other hormonal medications, including oral contraception and hormone replacement therapy, and laid the groundwork in Canada for organizations including the Canadian Women’s Health Network and Women and Health Protection—organizations that continue to speak out about the dangers especially of the newer drospirenone-containing contraceptives as well as a range of other problematic pharmaceuticals.

Despite the flaws, Sweetening the Pill serves up a feast of interesting topics related to the main theme of the book. In describing her own journey of discovery about birth control, Grigg-Spall chronicles the history of birth control, citing a range of sources and perspectives, from feminists of the 1960s, Catholic nuns and the abstinence organization 1Flesh promoting the Creighton Method of fertility awareness (along with an unhealthy dose of religious rhetoric), and even a reference to the philosopher Foucault’s concept of “biopower” (the idea that to control fertility leads to progress).

The section comparing cultural attitudes about birth control in the United States with those in Japan makes for some especially interesting reading, including Grigg-Spall’s speculation about why women in Japan are much less likely to choose hormonal contraception and instead are more likely to use condoms and fertility awareness methods. As with many of the topics she touches upon, the reader may be inspired to investigate further using Grigg-Spall’s bibliography as a starting point.

“The Recovery” chapter sheds light on fertility awareness methods of contraception and is particularly informative, making a strong argument that these underused contraceptive methods are available as non-hormonal alternatives and have the potential to reconnect women with the workings of their own bodies. Sweetening the Pill is Grigg-Spall’s plea for women to pay more attention to their bodies, to make decisions about health care with self-knowledge and more “women controlled” birth control methods that “enhance communication.”

The Fertility Awareness Method (FAM) is “based on observing and interpreting scientifically proven signs of fertility to prevent or achieve pregnancy and monitor your reproductive health.” By monitoring cervical mucus and ovulation cycles, women determine their fertility at different times during their cycles, supplementing during fertile times with barrier methods (condoms) and spermicide. This method also assumes access to emergency contraception and abortion.

Fertility awareness is one of the main themes of Sweetening the Pill inspired by Grigg-Spall’s own realization that she had a lot to learn about her own body, and her fertility in particular. Grigg-Spall also refers women to the guide to getting off the pill that she developed with Canadian women’s health columnist, Laura Wershler. The guide is available through her website. She provides references to other practical resources for women who do decide to stop taking the pill, including the new Justisse app for charting ovulation and menstrual cycle.

Toward the end of the book, Grigg-Spall speculates: “What if women did not adapt to the system but decided to change it, starting with tuning back into their bodies and their collective power?”

Her hope for the future echoes the hopes and work of feminists from the 1960s and 1970s and earlier that women would take their health into their own hands. It’s encouraging to read and hear about this revival with its fresh feminist perspective. Certainly, Grigg-Spall has highlighted several inspiring young women and organizations, including menstruation activists and the bicycle-riding Ovarian Psychos who created the “ovarian gang symbol” featured on the cover of Sweetening the Pill. The symbol and similar activism is all about empowering women to reclaim their bodies, using current culture and technologies to share information.

I do not see the criticisms of Grigg-Spall’s first book discouraging her from continuing to voice her passions on this topic. From the comments on her blog and the anecdotes compiled in her book, it’s clear that many women are seeking alternatives to hormonal contraception, especially in the wake of news about the adverse and sometimes deadly effects of pills such as Yaz, Yasmin and the acne medication, Diane-35. This is an extremely important and timely issue, and keeping the debate in the news will help inform more women that, for these pills in particular, there are safer alternatives.

Ellen Reynolds is editor of Network magazine and research coordinator of the Pharmaceutical Sales Representatives and Patient Safety study at the University of British Columbia. She is based in Victoria, B.C.